Transcript

Good evening and welcome to the Health and Adults Subcommittee meeting. My name is Councillor Mohamed Balal Uddin and I will be chairing this meeting today. Only members and persons can be voted and does not include the co-opted. This meeting is being recorded for the council website for the public viewing. If there is any technical issue, I will decide if and how the meeting should be continued after taking the advice from officer. Can I remind members should only speak on my direction and ensure to speak clearly into the microphone. Please have your phone on silent. Member officer and speaker who are only online, can you keep microphone on mute except when speaking. If member and officer online wish to speak, please use the raise hand function. Apologies. Justina, have you got any apologies today? Yes, Chair. We have two apologies from Councillor Iqbal Hussein and Councillor Bodo Chowdhury. Thank you. The minutes from the last meeting, 3rd of September 2024 have been sent. Can the committee member confirm this is the true and accurate record? Thank you. The action log has also been circulated in the agenda pack from the last meeting with the response from the service. Do members have any comment? Thank you. Our next item is declaration of interest. Can you introduce yourself and declare if you have any DPI, starting from myself, nothing to declare. Nothing to declare. Nothing to declare. Nothing to declare. Nothing to declare. Nothing to declare. Nothing to declare. Councillor Amy Lee, nothing to declare. Councillor Sabina Khan, nothing to declare. Councillor Aprymena, nothing to declare. Jessica Chiu-Karpsi, nothing to declare. Thank you. Thank you very much. Anyone online? Justina? No, Chair. No one's online. Okay. Thank you very much. Thank you. the first agenda today. Before we start the item, we have a request from the service if we can do the support from the 55th item first as some of our witness need to leave for a certain time. On this occasion, I am happy to agree this, which would mean to slightly take to our agenda order. Justina, can you note the one, please? Our first item for the evening is focusing our support for the over 55 preventative care for the people over 55 is vital due to the increased risk for the chronic condition such as heart disease and diabetes. quality of life, reduce health care costs, and help the catch-up health issue early. Regular care can use the longer health. Can I welcome to the Councillor Goulam Kibje Choudhury, Cabinet Member, Health and Well-being and Social Care, and lead to the lead member. I would like to also welcome to our next speaker, Larissa Howlett from the UK, Emily Bart from the Link 8 Plus, and Katie Taylor from the Link 8 Plus. I would like to request, I understand we also have Saman Menardji, the Public Health Director, and also Doreen Ingram, the Head of Service for Living, Well and Commissioning, who may also say a few words and take the question if you want. Now I would like to hand over, you will have to 10 minutes provide the committee overview and there will be open up to the member, question to the member, please I can take the hand over to the Goulam Kibriya, your time will be 10 minutes. Thank you. Thank you Mr. Chair. Thank you for bringing this paper on the ways that our councils support on one of our most vulnerable and neglected demographic groups. The fact that Tower Hamlets has such a high rate of older people living with ill health and in poverty is a tragedy, and one that our administration has been working hard to end. Along with the service mentioned in this report, we hope that induction of free home care, the further development of extra care homes, additional investment in community support and a major public health campaign dedicated to preventing and addressing long term conditions will go a long way towards keeping our older residents healthier for longer. Thank you Mr. Chair. Now I would like to request to our Sumon Bernardito, and Warwick, please say a few words. Great, thanks very much, so I'm going to introduce this and I'll pass on to Warwick, so I'm going to talk a little bit about the health trends in over 55s in the borough, so there is a little bit of information in the pack. I think some of the key headlines for the older populations in Tower Hamlets is that we have a significantly lower proportion of residents aged 65 plus, so it's 5.6% compared to about 10% in inner London and about 14% in outer London and 20% nationally, so it's a much smaller proportion of older people in the borough. It's important to note that the over 55 population is projected to grow rapidly over the next 5 to 10 years at a higher rate than elsewhere, so we're expecting to see a 31% increase in 50 to 64 year olds and that's between 2021 to 2030 and a 38% increase in the 65s and so that's very important from the perspective of demand on adult social care and demand on the health and care system more broadly. It's really important to recognise, and this is in the paper, that in relation to over 65s Tower Hamlets has the highest level of income deprivation in the country and that accounts for significant health inequalities in older people. Looking at the census data for 2021, we see that self-reported health in over 60s is significantly worse than the rest of the country and then when you break that down by deprivation, you find that in the most deprived, it's about 50% of over 65s report self-reported disability compared to 20% of the most affluent, so in the borough, it's about, in the most deprived parts of the borough, the levels of health are about 2.5 times worse than the most affluent so it's a real significant inequality. There's also inequalities in relation to the Bangladeshi and black older adults who have significantly higher levels of stroke, diabetes and heart disease. And then if you look at some of the data in the over 65s in relation to what's called basic activities of daily living, sort of washing, cooking and sort of basic activities, you find that it's an estimate but about 30 to 40% may have some issues relating to daily living which may relate to need for adult social care and 44% of over 65s have four or more long-term conditions and around 44% of those receiving adult social care live alone which is significantly linked to poorer health. So I think those are just some of the key trends. I think that the key underlying headline is that we have a lower proportion of older people in the borough but they have significantly poorer health compared to the rest of the country and there are significant inequalities within the borough in relation to the most deprived parts of the borough and the least deprived. So I'll stop there and I'll hand over to Warwick. Thanks Shoman. So I'm not going to say very much but Shoman's just given an outline around the needs of the population in the borough and I just want to draw your attention in the report to the diagram that you've got in paragraph 4.4 and that just gives you a bit of an overview of the range of services that we have in the borough and somebody's journey into adult social care and the services and support that they might receive kind of in an escalation of need depending on their levels of need. We've focused for today on services that offer more around the preventative early help kind of offer rather than all of the range of services that we have as part of adult social care. So we have our two providers here Linkage Plus and Tower Hammers Connect and there's a brief description of them in your paper but I'm not going to take you through that because they can obviously tell you that far better themselves than I can so we'll hand over. I'm not quite sure where we're starting but over to you. Thank you very much Warwick and thank you to the Chair for rearranging the agenda so that I can leave by 7 o'clock, much appreciated. So my name is Larissa Howes, I'm the Director of Services for Age UK East London. Age UK East London is an independent charity that's been delivering support and services to older people in Tower Hamlets for over 30 years. We work specifically with anyone aged 50 plus and their carers and primarily our top line mission is to support older people to maintain their independence for as long as possible. We are the lead provider of the Tower Hamlets Connect service and broadly speaking Tower Hamlets Connect in my mind can be viewed in two key phases, the first one being our helpline which takes all referrals into initial assessment for adult social care in the borough, runs screening calls, triages those and ultimately aims to support residents to access the help and support they need within the community rather than needing to be assessed by adult social care and embarking on a journey of what we would call dependency. And then below that we have 8 partners, 8 community partners, other voluntary sector organisations, I've listed there included in the presentation that hopefully you have in your pack. I would say by and large one of the things that unites all these partners is that they are accessibility experts, that means they are experts at working with those residents who may experience some of the greatest barriers to support and services in the borough and additionally pretty much all of us provide a whole suite of extended services beyond information and advice as well. All of those partners and ourselves as part of Tower Hamlets Connect have advisors, information officers and advisors advising on anything from welfare benefits through to consumer issues and general advocacy and those services are based, we have those services present in every single health care setting, primary health care setting across the borough currently, again enhancing the accessibility of the service. Moving on to accessibility just to reassure members in terms of the, I mean Tower Hamlets Connect will support anyone aged 18 plus in the borough but what we note is that when we look at the people that are coming through our helpline 86% of those residents are aged 55 plus and when we're looking at the community based offer particularly in the health care settings we find that 55% of all residents accessing those services are aged 55 plus. I also have provided you some data there on the ethnic profile of the residents that are engaging with our service which we find to be reflective of the profile more generally across the borough. And then in terms of our achievements and actually what we achieve for residents through provision of our services we find that we are able to support referrers 73.44% of all referrals into our helpline are actually diverted and supported within the community. So that's 73% of people who initially come to the service requesting or having been referred for intervention by adult social care, assessments, OT assessments, etc. We are able to help them quicker and to support them to access the services and support they need independently. And then it's interesting to compare that to the UK national average of 58% across all other adult social care services in the UK. I think we play a very important role with regarding safeguarding vulnerable adults. We triage and screen all safeguarding concerns before they come to duty in initial assessment and we are able to again support over 66% of those referrals in the community. And just finally to say in terms of the welfare benefits advice that we provide in those GP settings on an annual basis our advisers are uncovering roughly 3.3 million pounds of unidentified entitlements for residents. So I'll leave it there. I believe I only have seven minutes and I'll leave some time for your questions. You've all got the presentation in the packs. So my name is Emily. I'm the Community Partnerships Manager overseeing Linkage Plus at Toynbee Hall which is the lead partner for Linkage. So Linkage Plus is a vital service supporting residents over 50. Its mission is to improve wellbeing, enhance social networks and tackle isolation, in turn improving health and wellbeing outcomes for residents. Linkage Plus supports older adults to age well with their own resources and that of their communities whilst retaining choice, control and independence. It facilitates access to a full spectrum of services provided by the statutory, VCS and independent sector through outreach, time posting and referrals. And the programme operates across five main hubs. St. Hill Disease Community Centre, Sunali Gardens, Age UK East London, Sundial at Peabody and Neighbours in Poplar. And I'm going to talk about some of the key elements to Linkage. So Monday to Friday Linkage Plus acts as a warm, safe and motivating environment to socialise, take part in a range of activities and receive one-to-one support. Our in-person programme includes social gatherings, learning opportunities and intergenerational projects. Physical activities such as chair-based yoga are designed to accommodate people with varying levels of mobility and celebratory events across the cultural calendar foster greater understanding and community cohesion. There are offers for underrepresented groups such as LGBTQ plus older adults, people living with dementia and their carers, men's mental health groups and projects led by ethnic minority communities. And so far this year, April to September, we have delivered 375 physical sessions across the hubs, 602 social sessions, 365 learning sessions which includes 114 digital sessions as well as 52 special events. So given the complex health challenges facing the over 50s in Tower Hamlets, health promotion plays a pivotal role with high rates of chronic and long-term conditions. The programme offers talks and workshops led by specialists to help service users better manage their symptoms independently. We collaborate with preventative health teams to raise awareness about conditions such as Parkinson's and diabetes with health promotion events featuring practical services like blood pressure checks, cancer screenings and vaccinations. On registration to linkage, staff conduct a false prevention survey and make onward referrals to the team at Royal London Hospital and so far this year we have conducted 223 surveys. Linkage plus outreach workers play a vital role in engaging with clients both in person and remotely to provide tailored one-to-one support and their primary objective is to empower older adults to make independent and informed decisions. Outreach workers facilitate access to relevant services offering essential practical support such as creating and managing online accounts to claim benefits to help people navigate an increasingly digital world. Outreach takes place with partner organisations such as sheltered housing with drop-ins delivered across the borough in places like GP's practices. Staff promote the service at networking and community events and some of our referral partners include Royal London Hospital Teams, Tower Hamlets Community Advice Network, Tower Hamlets Connect, Tower Hamlets Floating Support, the Robertson Centre at My Lend Hospital and Carers Centre at Tower Hamlets. Outreach workers speak a number of community languages with a significant amount of support offered to making systems, processes and information accessible to older people, particularly those with English as a second language, low reading and writing skills, low judicial literacy and people unable to leave their home. Last quarter we provided a user with practical support which resulted in a backdated payment of £5,000 which is a life-changing sum of money and that service user said they wouldn't have been able to get that award without the help of Linkage plus outreach workers. So far this year we have provided 516 instances of practical support which is 81% of our yearly target already in Q2, 331 instances of signposting and 289 referrals. A unique feature of Linkage plus is the active involvement in service users so older adults are valued members of the project who actively shape what is delivered. They attend quarterly meetings at each hub where they provide feedback and influence decisions and this co-productive approach ensures the service meets real community needs. We currently have 14 peer groups operating across the hubs and those are groups that are delivered and managed by service users promoting a sense of achievement and purpose in older age. The Tower Hamlets Older People's Reference Group led by Age UK East London is a forum for older residents to voice their opinions on local services and influence decisions that impact their lives. OPRG members engage with service providers, participate in discussions and help monitor the implementation of key policies affecting older adults in the borough. We also have opportunities to engage in participatory research and last year 13 service users created and conducted a quality survey of Linkage plus with results and recommendations being fed back to staff. So whether it's through fitness sessions, digital inclusion initiatives or a simple chat over a cup of tea, Linkage plus ensures that no matter your age you can stay active, socially engaged and empowered within your community. Thank you. Thank you very much. Thank you very much for your presentation. Before we can go to the question I would like to request one of our colleagues just joining late. I would like to request to please kindly introduce yourself and if you want any declaration please. Thank you Chair. I'm really sorry for being late this evening. I'm Councillor Mark Francis from Boat Eastward. Thank you. No DPIs. Thank you very much. Thank you. Do members have any questions? Yes, Councillor. Hello. Hi. Thank you for the presentation. I just want to say it's a privilege what you're doing. Not many people get to do help being on the other end helping elderly. What I want to know is how you set out your amazing achievements in terms of income generations and all the outreach programmes you do and the help support you provide to elderly residents. Could you tell me a bit more about your staff, the people who provide these services, how do you make sure they understand safeguarding, they have health and safety and how do you look after them so they can look after our elderly better? We have staff of 12 helpline advisers. They're all recruited from aligned health and social care backgrounds. We've got a number of ex-social workers. We've got former IDVA's, domestic violence advocates. They're all very experienced working alongside the health and social care piece. We have a tremendous relationship with adult social care. In Tower Hamlets we've been a trusted partner for three or four years, the life of the contracts. Larissa here sits on safeguarding boards in Hackney. Our recently retired safeguarding lead, Deborah Hayes, was also on the safeguarding board in Tower Hamlets. We have an exhaustive training and support in place for all of the helpline advisers. We've got a number of Bengali speaking helpline advisers as well. What more can I say? I'm Adam by the way. I'm here to support Larissa because I'm the service lead for Tower Hamlets Connect. We also have involvement with Linkage as well. Following from that, I just want to ask you how secure are you in terms of funding that you can continue the service going forward in the next year or two? Hi. We are currently undertaking a review of the service and we'll be taking some options through for our DLT and then through to the lead member and the mayor to look at the future funding arrangements at the moment. We've done a review of how the service is operated and looked at some of the potential future options so that's being explored at the moment. We're currently in contract until March 2025 at the moment with the option for a further extension so we're also exploring that at the moment. Okay. Thank you. Our next question will be after Amy. Thank you. I just wanted to ask about the sort of age range that we're working with here because we're talking about older adults but to me, 55 isn't old at all. Is that a case of just trying to cover all the basis or are we seeing an increase in need earlier? Because I feel like that's possibly the case but then what kind of need is it? Is that specifically sort of health or is it connected to the longiness issue and is that perhaps not unique to this borough but is this something we've noticed here more than perhaps in other places that this need for this kind of service is coming in earlier? We can do a joint number on this but I'll start. So first of all, the 55 benchmark was given to us in preparation for this meeting so I'm not sure whether why it was decided that that was the sort of turning point. More widely, as an organisation, Age UK London, we do say that we work with people aged 50 plus. I think historically a lot of that is done in recognition of the age that many people start caring for people who may be a bit older than them but specifically we work across City Hackney, Tower Hamlets and Newham. These are the three poorest boroughs for people aged 55 plus in the whole of the UK and we do see long-term health conditions starting sooner across all of the boroughs that we work in. So I think we, from that perspective, I think it's an appropriate age range to start thinking about the support and of course we are in the business of prevention as well and so we try and support people as soon as we can. A lot of people are not willing to define themselves as an older person, even at the age of 55. I can certainly say that from a personal perspective. So it's tricky to sort of market support or to reach people much sooner. Adam, you might have a view in terms of Tower Hamlets connect specifically and any trends. Yeah, I suppose the 55 is really an indicator of the health inequality in the borough, I would say, particularly among certain demographic groups. We do support all adults over 18 but the vast majority of people who contact us are either people who are experiencing some of the difficulties with the ADLs which Shoman listed earlier so that can be as simple as kind of washing, dressing, cooking, Larissa mentioned caring as well. So obviously you often get quite young working age people caring for parents around that age as well, beginning to kind of, you know, require support in that respect too. Yeah, so he was just to kind of support what's just been said. We've got, we recently got some data which shows the age at which people in Tower Hamlets start to develop long term conditions like heart disease and diabetes and that is significantly earlier than the sort of national average. We've also done a needs assessment around adult social care and what we're seeing is an increase in demand for adult social care in the over 55 populations, increased complexity in the 65 plus. So I think that sort of 55 is a very relevant threshold for Tower Hamlets. So, you know, we've seen a lot in the press recently about, you know, working age people, you know, being on sort of long term benefits, disability benefits, those sorts of things as well. So that is indicative, you can see, in the amount of income that we've generated for our residents because they often experience a life changing trauma, something like we, as Shoman mentioned at the start, heart attacks, stroke, those sorts of things. They're the people that really need very good information and advice around accessing social care but also welfare benefits as well because often people are not really thinking a great deal about their health, rubbing along quite well in jobs and then they experience a life changing trauma. At that point they need a service like Tower Hamlets Connect to give them that kind of holistic assessment to make sure that they're claiming their benefits, that they're, you know, they're getting the right support in the community from community health, physio, falls prevention, as Emily mentioned. I just wanted to add that the demographics for linkage, so people coming in person and receiving support on average is around 70. However, some areas such as Spitalfields and Bangletown where Twinby Hall are based, it's slightly lower at 66. We are seeing a trend in an increase in men under the age of 65 receiving support through linkage plus and majority of that is to do with welfare benefits support. We are also seeing a number of men who have recently divorced or become single during the pandemic who are also now accessing our service. So we're slightly seeing the closing of the gap between women and men in our centres across the board, but still I would say it's majority of women are accessing the service in person particularly. Okay, thank you. Thank you very much. Next question will be asked Councillor Ahmed Al-Kabir. Hi, good evening. Thank you for your presentation, Shuman and Warik. I have a couple of questions for you guys and I'll come back to you guys afterwards. Firstly, what do you see as the specific key health challenge faced by Order Tower Hamlets? The second one would be how do you include the older people referring group play and decision making? Thanks, Councillor. So from a health perspective I think it sort of reflects what I've been talking about in terms of the relationship between deprivation and poor health. So what we see is that the older population, they don't just have one condition, they have several conditions that they're managing at the same time. So that might be diabetes, heart disease, it might be because we have quite high levels of smoking in males in the borough, they may have lung conditions and other conditions. And actually related to diabetes particularly in the Bangladeshi community, really challenging issues like kidney disease, dialysis and those sorts of things are sort of more prevalent than elsewhere. So I think the challenge is to be able to support, prevent those conditions, support multiple conditions which is a challenge for both the health and care system and social care and to support them. The other thing that I mentioned is that a significantly higher proportion of people receiving adult social care live alone and that also creates a lot of issues. And I think services like Linkage Plus are really critical in enabling people who are living alone to connect and it can actually be very small things that enable people to feel safe to go out and engage with others because that is actually really critical to people's wellbeing. So I think, does that sort of address the question? The decision making, as I mentioned, like the second question, while the older people reference group play, how do you make decision making? So I think how we involve residents and older people in designing the services they're using, is that what you're asking. So every time we recommission a service, we always use different ways of engaging with residents to help us design that. So the services that you've got outlined in your paper all had residents' engagement in terms of designing them, but also specifically Linkage Plus run activities around engaging residents and the people who are using their services to help inform future services and future areas of need that we might need to meet. I don't know if you want to add anything to that. Yeah, I mean we run quarterly service user meetings across the five hubs and that is really people's opportunity to say what is working and what isn't. And that can be what is working for them within Linkage, but also with other places that they're accessing in the borough. Recently we've had an increase in people giving feedback on what's been a long term issue, but the lack of free foot health care in the borough due to the changing criteria when part of the service at My Land Hospital was decommissioned at the end of 2017. And that is still an ongoing issue for many of our service users. And I guess it's my job and other staff within Linkage Plus to make sure we're feeding that back to our commissioners so then they can feed that back to their networks and so on. So I think it's making sure that there's a clear feedback loop for people, not just to frontline staff, but to those people that are making the decisions that we also don't have control over. Yeah, and obviously the older people's reference group has been really key for residents to speak with the people who are providing and designing the services they use. And I know that Grace, who runs the OPRG for Tower Hamlets, has multiple guest speakers over six meetings in the year, and many of those are from public health, as well as they recently held a consultation with residents about community cohesion, so the older people's reference groups was one of those key places that they went to to hear from residents about how this would impact them. So yeah, those are the main channels for people. I have a question for you, Emily. While the Linkage Plus prescription was helpful, it still doesn't provide much details on the actual services that Linkage Plus offers to our residents. Can we please have a clear overview of the services Linkage Plus provides? Yes, I think it's because we do so many things, it's hard to fit it into the presentation, but our in-person programme covers physical exercise, and that can be anything from dance, seated exercise, chair yoga, to ballet. That is our biggest and most frequent activity, is exercise classes. Then we obviously have things like our cultural calendar, so events across the year. We often do trips during the summer. We run digital IT sessions, both group and one-to-one. We deliver a number of creative sessions across the hubs, which is particularly popular with people. Intergenerational work, so providing opportunities for older and younger people to connect with one another. And then the one-to-one support. And the one-to-one support, which is I guess what we're seeing more of a need for is that one-to-one tailored support. Particularly, we've had a real increase in benefits support, and I think the changing systems that people are having to navigate, that people are having to navigate when they don't have English as a first language, when they have low reading and writing skills, and they're receiving letters, that is where our outreach workers come in. We're not an advice centre, we can't give advice, but we can tell people, this is what your options are based on what you're telling me. We can signpost you here, we can refer you to here, and we often follow people through their referral pathways and we check back in with them to see how and if their issue has been dealt with. And if not, we will then reassess their situation and find them other alternative services. More often than not, we are taking on that work ourselves, so we are doing a lot around benefits support in terms of application and form filling support at the moment, particularly with the winter fuel payment. That is going to dramatically impact many of our service users, so we at the moment are doing a push to make sure people are maximising their income, if they are eligible for pension credit, they are on pension credit, if they can get council tax reductions, they're doing that, looking at their energy supplies, make sure they've got the best deal. I would say that is our main concern at the moment, is coming into those winter months without that winter fuel payment, is that one-to-one support, particularly for the Bengali community, so our Bengali-speaking outreach workers are sort of, yeah, they're invaluable really. Okay, thank you very much. Thank you. The next question will be our councillor, Abul Mannan. Good evening. My question to the corporate director and the linkage as well. The report is produced, it seems to be promoting the work that linkage does rather than providing a balanced assessment for us to scrutinise. Are there any steps linkage could take to improve these services? Do at the social care staff monitor these services? So basically they're doing the work, are you monitoring the services, how are you monitoring from our point of view, from council? Also, how do we promote or advertise our services for over 55 to our residents? Those two questions. I've got a few more questions after. Who's going to go? On the point of how adult social care monitors the quality of Tower Hammers Connect support, I can tell you that we've had, we have previously given the initial assessment team access into our system and they have been able to quality assure the case work that we have been doing, the risk assessing that we have been doing and the screening that we have been doing. We have monthly meetings with key colleagues in initial assessments and those are opportunities to share feedback, to conduct case reviews, to collaboratively and to continue to improve the service. So we very much work to a continual improvement cycle and we work very closely in partnership with our colleagues in adult social care and also in commissioning. In terms of promoting, I can speak for ASUK East London, in terms of promoting services that are available to older adults, we deliver comms across multiple channels. We use digital channels because we are aware that carers and friends and relatives do access our services in that way. We do a lot of hard copy paper marching, as I call it, which is literally taking leaflets. We have marketing comms in every single health setting where we deliver services across the borough. We have them in our own centres. We use the older people's reference group which has a membership of something like 700 individuals from across the borough as a key channel for sharing information about our support and services and of course there is the Tower Hamlets Connect portal which is a dedicated digital resource for support and services for vulnerable adults across the borough. I knew some residents who had an issue with the quality of referral to the TSCS website. What are we doing to ensure the information and advice for the older residents is the highest quality? I'm going to need to defer to one of our colleagues from the council because actually ASUK East London does not administer the website. So if I start and then I'll ask if Darren wants to add anything. So we manage the website internally. We own that website and we manage that. It's an ongoing development really to make sure that that's kept up to date and that it's kind of user friendly in terms of searching for services that you may want to search for as a resident. So it's developed. It's not the same now as it was when we first started the service when Tower Hamlets Connect began. I don't know if any members have used the website. It's relatively straightforward to use but there's always room to develop it further and we kind of would welcome feedback from people who've used it and not being able to find something. That's an ongoing piece of work. So the original design of the website was done with residents and older people as we developed the service as well. So we did have input at that point. But as I say, we're really happy to take any feedback and actually we would use some of the routes that we've got through Tower Hamlets Connect and Linkage Plus to engage older people and look at how we can develop that further if we need to do that. Okay. Thank you very much. Thank you. Our next question will be asked, Jessica. Thank you, Chair. That was really good by the way. I am really grateful that you can speak to us about that and the work that you're doing. I think it's fantastic. I just wanted to ask a couple of questions just around some things that you've said. So one question is for Larissa, and I'm so sorry I've forgotten your name, Adam. Just about you mentioned about working in, is it with GP practices or physically located in GP practices and how the kind of working partnership is, whether you are kind of working with the NHS or whether you are just seen as somebody using the GP practice. And then I've got another question just for Emily. Because you mentioned about the issues you were raising to the commissioners, et cetera, et cetera. And I wondered what your mechanisms were about raising it, the challenges that you've heard from the older people's reference group to make sure that they are heard. Because I know that there's only so much you guys can do to speak to, but I wondered whether, and this might go to everyone really, how you could be more supported in that to help improve the services. Because there's a lot of work that you guys are doing, but there's also a lot of other services and health and care providers that could support you guys, I guess. Sorry, that was very too strong. As far as I work with GPs and more widely primary care goes, GPs are among the most kind of pressed professionals working in the NHS. But they do notice quite a lot of problems. I mean, I can't, I don't have the stats to hand, but a lot of GP appointments are for social issues, the wider determinants of health. So we've got a really good relationship with the GP care group. We've been promoting our advice and Tower Hamlets Connect service amongst the GPs. But the core of our work with primary care really happens with the social prescribers. So we regularly attend the social prescriber meetings, the social prescribers amongst the PCNs, primary care networks have been linked in with Tower Hamlets Connect with the specific advisors who are working in those PCNs. So we've tried to map the providers onto each PCN so they have a really good relationship with the person who can help the patients with the advice work. We've done a hell of a lot of work with the care navigators and the social prescriber managers to improve referrals into Tower Hamlets Connect, not just around information and advice, but also kind of inappropriate referrals for sort of health and social care as well. When we first sort of launched Tower Hamlets Connect, there was a huge issue with social prescribers not really understanding how the Care Act worked and where the support was in the community for things like falls prevention, community physio. We've reduced that dramatically so that social prescribers now, rather than sending referrals into social care, for us then to advise them that they actually need to see a community physio, all of that has been largely removed from the whole system. The same goes for the care navigators as well. We regularly attend the care navigator meetings. I've got an excellent relationship with Francis Colley, who's the care manager lead, so we can share information. We can make sure that referrals are appropriate. We can find out if someone's being supported elsewhere to kind of safeguard as well. So the service has got sort of other applications beyond its kind of initial purpose really. Yeah, so I think for us it is really key to make sure that the issues that are being raised by the older people that we work with are fed back to the council, because again there are things within the service that we can affect, but we're working in this wider environment where a lot of it is out of our control, but we do see a role to kind of advocate for things like the foot care issue, for instance, that Emily raised. So we definitely raise those with our commissioners, but I think we're always looking for other opportunities to make sure that those messages are getting through, because some of them are things that are incredibly impactful for the older people that we're dealing with, and because we're a front line service, we're often coming across things as kind of, we're the first ones to see sometimes some of the issues that are affecting large groups of older people. Yeah, and I think at Toynbee Hall we have a community advocates programme where older people are involved in the production and carrying out of research that is about them, so it's based around participatory action research. We are at the minute doing a little bit of internal research on housebound residents and the needs of housebound residents, and that has come about due to lots of referrals coming in to linkage plus for support for people who are housebound. We've only conducted a few interviews at the moment with residents who class themselves as housebound, and it's a huge spectrum of from one person can still drive if someone's in the car with them to someone who cannot leave the house at all. So it's gathering information from not just the service users but also the staff who are also in touch with social prescribers, social workers, and bringing back all of that information internally so that we can have a look at the themes that are coming up, and it is additional funding to do this research and to develop something for a particular group of older people that we're seeing there's a big need for, but that is something internally we are doing at the moment is looking for additional funding for research with people who are housebound about what their needs are and what their recommendations would be for the types of services that they're needing to access about how they can access them better essentially. So yeah, it's what we're here, we put into action if we can, but obviously that comes at a resource and a cost with it as well. And we'd love to invite you to an older people's reference group meeting as well. We've got one coming up at the start of August. Okay, thank you very much. Thank you. And our next and final question, we ask our councillor Mark, please. Thank you very much, Chair. Thank you for the presentations. It's great to have an update about Linkage Plus, and it's right. I think that the whole of this project and this part of what the service that the council supports is given some prominence. We're here to do scrutiny and I'm going to come back to with some harder questions. But so my my memory is that not only have I been around long enough to have to be a potential beneficiary of the service, but I've also was in the cabinet when we decided to mainstream this service from the original pilot from the Neighborhood Renewal Fund and DWP as well. And I guess like that, the initiative that was being taken then, one of the eight pilots around the country, we hoped that the whole thing would be rolled out and, you know, with that we were moving to, we were putting another few bricks in the wall of building New Jerusalem. Sadly, that turned out not to be the case. And obviously over the last few years, the council especially has lost a big part of its funding, core funding, if not the public health part of the budget. So I do just want to kind of come back to this point that Councillor Mannan's raised about how we can, I guess, be assured as a scrutiny committee and thereby make recommendations to the to the mayor and to the executive about the future steps for the project, for the two projects. So we, Councillor Mannan was asking about, I guess, about the metrics for the service. And, you know, I understand that we commission it and I assume that there's kind of regular dialogue through the course of the year and that there's then like a kind of a more formal stage of checking. And we obviously have the contract review that was talked about earlier. Can you give us, so you've given us an indication about some of the numbers, but can you give us an indication about what you feel in terms of the level of the numbers of people that are being served directly and the numbers of people that are not yet being reached? What's the kind of the untapped number, need and demand that's there in our community at the moment? I mean, I would say it's it's people who are housebound. We get a lot of requests and a lot of referrals from people who need support to get out of the house. But it wouldn't be appropriate for that to be a volunteer or a befriending service because that person has those multiple complex needs. And there would be lots of safeguarding in place. It needs someone who is a professional, who is trained in the needs of older people. But that is the biggest need that we can't meet at the moment is people who want to get out, but cannot on their own, but are also living with these complex needs, which means it can't be a befriending, it can't be a volunteer because it wouldn't be safe for either. So I would say I don't have the figures on that. I think we support people remotely with things like benefits. We also support people in person with things like practical support and accessing other services. But we don't have staff who can go and pick someone up in a taxi and bring them to our centres so that they can take part in social activities. And there are lots of people out there who want that and would benefit from that. But there's been lots of issues with people's usage of diloride, lack of community transport, lack of, I would say, an understanding from public transport about the needs of older people when they are using it, and lots of people reluctant to obviously use public transport during very busy periods. Or if they do have health issues, when they can't guarantee that if anything happens to them on that journey, that they're going to be seen to by people who know what they're doing. And those people who are living alone, majority of our service users live alone. And there are people who are living alone who are housebound as well. And then I would say our most vulnerable people that we currently can't meet their needs. I'd be interested to hear officers' view on that as well. And then I wanted to make a comment afterwards as we come to the end of this and kind of what we do with this information beyond this point. But you talked about the partners that are involved. One of the organisations that wasn't mentioned was Gateway Housing Association, who are the principal provider of sheltered, independent living, however you want to describe it, social housing in the borough. Are they actively engaged in these partnerships? And do you feel that the residents in their homes have got a lot of their tenants in my own ward? Or that they understand enough about the potential opportunity provided by Linkage Plus and Connect? So we work closely with sheltered housing, but it has become more difficult since the pandemic. Previously, our experience of sheltered housing was that there was, for most places, a sort of vibrant community, communal feeling to sheltered housing. And that has really, really changed since the pandemic. A lot of that was due to the fact that communal areas were completely shut off and residents were not allowed to use them for extended periods of time, sometimes years, at some sheltered housing. So getting people back to the sense that there is a communal atmosphere within sheltered housing is really difficult. People want things on site as well. So we work a lot with doing sort of droppings at sheltered housing, but people don't want to get a 10-minute bus. They want that exercise class to be at their sheltered housing scheme. And again, we don't have the capacity or the resources to fund sessions and classes in sheltered housing schemes. We do a lot of engagement trying to get people to us. But again, it's the resource to get our outreach workers into those places. Building long-term relationships and building trust with people can take months and months for some people before they'll even decide that they'll come and have a cup of tea with you down at your hub. So it is getting much harder to work with sheltered housing, I would say. But obviously, there are many, many older people that aren't living there. I think it's a question of how do we work with them going forward. We have lots more referrals from them in terms of one-to-one support around practical support for benefits and welfare. But getting people physically to a centre is getting more difficult. Can I just add something as well? I think it's really important to be aware that it's not just about the resource. In that situation, it's also about the limited resources that Gateway has now as well and the pressures that they are under as housing providers and their ability to enable our activities to be delivered safely and to support the residents to engage and to even promote the activities. To be honest, it was an issue pre-pandemic. So I think they're squeezing happening everywhere. The solution would not be necessarily to give us loads more resource in that situation. It needs to be met. It needs to be a partnership approach. Because the key to success is that trust piece and that relationship piece. Historically, those housing managers had that and that's why it was such a successful model. But they're unable to provide that level of coverage anymore and I think that's a real challenge. It's a challenge for people who are living in those shelter schemes as well in terms of a range of other issues that they experience in regards to their housing and their day-to-day needs, not just engaging with a service like Linkage. The Gateway does actually get money from Tower Hamlets Council, I believe, to undertake communal activities or to commission stuff in the shelter blocks that it owns and maybe some of the others do as well. Can I just ask officers if they can say something about performance? Nothing too gratuitous, obviously. Very quickly. So we monitor and measure performance from both providers as we do with all providers that we commission. So there's a set of KPIs and measures that we look for. That happens on a regular basis. It forms part of what we would use to review the services as we go back into recommissioning them, as the contracts come to an end. So I won't go into the kind of detail of it here, but there's a whole set of contract monitoring that happens as part of that. And just on the last points around levels of need that you're discovering and the issues around housebound residents particularly, I think that fits with some of what we hear from other services as well, but I think there's something there that we certainly would need to look at. Thank you very much. Thank you. Sorry, I can't take any more questions. I would like to emphasize the critical importance to preventative care for those over 55 by focusing on early detection and productive management and health and condition. We not only improve the quality of life for older adults, but also reduce the long-term burden on the health care service. Our goal must be to ensure that our community have access to the resource and the support needed to aid healthy and dignity and independence. Thank you very much for your time and thank you very much for your coming. Can I make a comment now about what we do with this information or do you want to hang on to the end of the meeting? I'll try and be very quick. Two minutes. Okay, sure. We can go on next agenda if you want to stay or you can free to go. Thank you very much. Thank you. Our second item that this evening is important area for our resident service user who will be in the received or community care. So with this in mind, we will be examining the Council Free Community Care April 2025 Revised Charging Policy. Can I welcome to the Council Gullam Kibriya, Cabinet Member Health and Well-being and Social Care, also Georgia Chimbani, our new Corporate Director for Health and Adult Social Care, Margaret Young, our new Interim Director for Adult Social Care. She's not here. Oh, sorry. Christiani. She's not here. Okay, then. Thank you. You will have to 10-minute provide the high level of overview and then we will open up for the member question. I can hand over to you. Your time will be 10 minutes. Thank you, Mr. Chair. I am absolutely honored to have this new charging policy come before ONS today as it makes a revolutionary step forward for this borough in providing for our most vulnerable resident. This new charging policy will allow delivery for free home care for all starting in April. For those suffering from long-term disabilities and health condition, free home care will be life-changing. In line with our strategic plan, the adult social care charging policy has been amended. This means that those who possess assets above the national threshold will no longer have to be assessed for a contribution towards the cost their care in receipt of community-based support. However, those in receipt of residential or nursing care will still be financially assessed and may need to contribute towards the cost of their care. Thank you, Mr. Chair. Thank you very much, Chair and Councillors. This policy, so we've had in place a charging policy. There's been some work that's been done on this policy that has been done throughout this financial year, so some of this predates Margaret and I joining the service, but nevertheless we have worked on this over the last couple of weeks and we've been briefed. The policy in itself has changed. The significant things that have changed in the charging policy has been amended to reflect the fact, as Councillor Chowdhury said, that from April next year the new policy will be free care, basically, for anyone receiving non-residential. And I think the policy gives details in terms of what that would be. So, for instance, things like day care, home care, and so forth, those services will be free. But if you are somebody who will require residential or nursing, that will still be assessed and there will be an expectation of a contribution towards your care. I think it's fairly self-explanatory, really, in terms of what the proposals are, but we'll pose there for any questions. Margaret, is there anything you'd like to add? There's not an awful lot, really, I can add at the moment to what's already been said. I mean, it's basically you have appended to the front part of the paper what will become the new guidance and policy, and it's basically an amendment of what we've got at present to reflect the impact of free domiciliary home care. And if anybody has got any questions that we'll either try to answer now or come back with answers for you at a later stage. Okay, thank you very much. Thank you very much for your presentation. Do members have any questions? Starting from Amy, Abina, and yes, Amy first. Just firstly, I might come up with another one later, but just the first thing that just jumps out at me in the main document is the comments of the Chief Finance Officer. So just briefly, the financial risk of an increase in demand for services is more difficult to quantify. Any increase in demand will need to be identified at an early stage so that it can be managed. Whilst I appreciate that a specific number is absolutely difficult to quantify, I think an increase in demand is almost an inevitability. So what work have we already done on this to figure out how we're going to manage this and what work will be done after it's implemented? Because that seems quite important. I think an increase in demand is somewhat inevitable. And I just want to know what plan we actually have in place for that and that it's not just going to come and hit us in the face and go wrong. Yes, it's something that finance colleagues have been looking at and they're constantly refining it because there's obviously lots of financial pressures around the system and we're very aware of it. And it's difficult to have any sort of precedent that we can look at that will inform us, but certainly something high on our agenda to look at. If I could just jump in, Councillor Lee. So my understanding of the process that's happened certainly throughout this financial year before I arrived is there's been looking at, as you say, the demand. So the demand has been looked at in two aspects. It's looking at a number of people that we currently already support within adult social care because they are people we support at the moment. Some people at the moment already do not contribute towards their care because of their thresholds in terms of their income or their capital. But there are some people who do contribute and, of course, from April will not contribute. So a lot of the calculations have been based on the fact that that is income that we've had at the moment that we will no longer have going forward because those people will not be paying. There's that aspect of it. There's also some work that's still actually being done at the moment in terms of trying to come up with an understanding of how to calculate the new demand. And it's quite difficult to get a sense in terms of how to pick it, but finance are actually working on that because we do know that even if we didn't have free charging, we know that there's an increase year on year. What we're trying to do is to try as much as we can to get to a position where we can forecast reasonably accurately so we know, for instance, that year on year we might have an increase. I'm trying to think. I don't know what the exact number is. But let's say we had an increase of 500 people every year requiring adult social care. What we're trying to do is then basically say, and what would that mean for implementation of free charging? And there's also another aspect in terms of we know from other boroughs, certainly it's Hammersmith and Fulham, who obviously are the only other local authority in London with free non-residential, that there may be, we don't know, but there may be a risk of people actually coming into, moving into the borough. But that is really difficult to quantify. So I think the biggest thing at the moment that we are working on, certainly in the next couple of weeks, and more than happy to provide an update once we've worked that through, is that aspect in terms of that demand in terms of new people who live within Tower Hammers, who we'll require. We just weren't able to get that in time for this meeting, but it's something we are working on. Yes. Okay, no problem. Thank you. Next question we ask, Abdulmanan. My question to the corporate. What work has gone into determining how this new charging policy will be promoting and communicating to residents, especially those with a serious disability, who would benefit most from this policy? And number two would be, are we doing any work to increase collection of current social care debt? If seen to be collecting much debt, would it be possible to help free home care affordability for others, for councils? So how are we collecting the debt money for councils to provide free home care for others? Am I clear on this? Thank you. We're in the process of fine-tuning the communication policy and the strategy around that, and we'll look at all the different groups we need to communicate with, and that will involve getting various methods and leaflets or videos or whatever we need to do to communicate with people, and that's very much part of our plan. Can I assure you of that? And in terms of the debt... So our position in terms of debt, as far as I know, hasn't changed. The mayor has been very clear that he wants us to continue, certainly until April, to continue to pursue any people who may have debt, who may owe money to the council, and there's a process around that that applies for anyone who may owe money to the council. Obviously from an adult social care perspective, one of the things we do look at is to make sure that in the pursuit of debt that we don't actually leave people who are incredibly vulnerable, left, for instance, without care, but that position, as far as I'm aware, hasn't changed. I don't know if showmen worry that you've got anything to add in relation to the historical issues around debt? No. Okay. You say nothing has changed, Mark. My fundamental question is, if we can't collect the debt, then how can we afford to carry on free home care for certain people? Apologies, councillor. I think I had misunderstood your question. Oh, I see. So what you're asking is how basically can we afford to deliver the free home care? How can we afford to deliver the free home care? It's difficult for me to answer that question because I'm still quite new to the council, but I think because the mayor, it is one of the mayor's pledges that he's been very clear that he wants this to ensure that this happens. So the money has been made available, the funding has been made available for us to be able to do that. It doesn't always rest solely on terms of debt. There are other means by which that money has been made available. I'm afraid I'm not privy to kind of where that money has come from. All I know is from a corporate director perspective, I've been told the money is available for us to be able to implement this. I don't know the specifics in terms of where that's actually been sourced. Can you provide that information later to our scrutiny so we could have it on the record, please? I can speak to the Section 151 officer and ask for that information to be provided. It's certainly not something that I have found from my budget, for instance. If it had come from health and adult social care, I would have been able to say because of an underspend here and so forth, the money has come from my budget. I genuinely don't know. I wouldn't be able to answer that. But happy to speak to the Section 151 officer around that. Thank you very much. Thank you, officer. It will be noted. Next question will be up to Councillor Ahmad Kabir. Hi. Thank you, Chimbani, for your lovely presentation. A couple of questions. How does the department make sure financial assessments are correct and fair? What steps are you taking if someone thinks their assessment is wrong? This is the first question. The second question is, can you explain the appeal process and how long does it take the appeal and how does the department inform people about their right during this process? I'll start and then my colleague may want to. So the way in which we undertake financial assessments for adult social care, it's governed by legislation around it. So all local authorities, we all assess in pretty much the same way, because there are thresholds that have been set by the government to say, I think it might be 23,250 as of August in terms of thresholds for financial assessments. So that is pretty much standard nationally. So in terms of how we ensure that those financial assessments are fair, it's the application of that law. We apply the rules and regulations that govern that in relation to that. If people feel that they've been treated unfairly or that their financial assessment is incorrect, then they have the right to actually come back to the financial assessment officer or to the department and we will have a look at that and we will explain it to them. The financial assessment process is very thorough because the financial officers will ensure that it can feel quite intrusive to people because by its very nature, financial assessments means you are asking people quite intimate questions about how much money do you have in the bank, do you own your house and so forth and so forth. And all of that is designed to be able to ensure that the outcome of that financial assessment is fair and proportionate. If people feel that it's unfair or they've not been treated fairly, then again, it's not an appeal process per se, but they can come back to the department and that will be explained and we will re-look at it. No appeal process? No, there's no appeal process, no. Next question will be at Councillor Mark. I think you just asked for a reassessment, don't you? I think that's kind of the appeal process. Okay, so this is the second of my trips down memory lane tonight. So twice in 2007 and in 2010 we fought a battle against introducing charges, means testing for home care and day centres and we won those and then in 2016 we lost and that's where the charges were introduced. So I want to put on record, I've said it before, but to the lead member and in fact to himself for, like well done, for realising that there is scope within the council's budget to reinstate free home care and to become the second borough after Hammersmith and Fulham that's still doing it, has continued doing it, to carry on. So I really, really welcome this. I've had so many constituents over the years who told me the difficulties and the challenges that they've had in terms of making ends meet irrespective of the financial assessments that are carried out. I think having said how much I welcome it, I do just want to probe what's actually being proposed in this paper though because I think a lot of the residents that are aware of this were expecting that this would have happened two years ago, not 15 months or so before the next election. And obviously during that period the charges have remained as they were. There's not been an opportunity taken to, for example, make slightly more generous the utilities allowance that's built into it and that has meant, especially in the cost of living crisis as energy bills went up, that those were completely out of kilter. So my question is slightly different to Councillor Mannan's one and it's about this issue of historic debt and how the council deals with it. And I appreciate that maybe officers can't really answer this question. But for me the question is, if we've made a political decision that people shouldn't be charged for this service any longer, why would we continue to chase people for outstanding bills in relation to this service? So just wondered if Councillor Kabeera or officers, if you want to respond to that point to start with. Thank you, Mark Francis. First of all, I welcome this. The thing is that because, of course, it is non-definitional debt, they will be rid of from 1st April 2025. But still we have before 25th April enough time in our hand. And this debt is continuing, not for this year or to 2022. It's continuing. We are taking this debt. And we have a lot of work to do this, to reduce this. And some cases we've been successful and some cases we've not been successful. And we have things, a lot of ways to collect this. For example, installment process. A lot of things we did. But still, in principle, we agreed those people have their ability, those people have suitability, they need to pay. This is our main... But in this policy that you've stood on and that you've adopted and implemented, essentially you accept the premise that people... Well, I assume you accept the premise that people can't really afford to be charged to pay these costs in the first place. And if you don't accept that, then I don't really know why you would do it, why you would reinstate it. I agree with that. I think there are some people in Tower Hamlets who receive home care who are relatively well off. But the number of those people is minimal compared to the number of people that really, really are struggling with those costs. And so I think this is kind of like council tax, isn't it? It's a similar thing. There is a point at which it's just not really worth it to continue chasing people for this kind of debt. Especially when, in this instance, you're saying, we're not going to levy this tax on you from next April anyway. So I understand you're not in a position to commit one way or the other, but it just feels to me, I've got constituents who raise concerns about what they're assessed as requiring to pay because of what isn't, they believe, should be taken into account but isn't in terms of the cost of their disability, but also the manner in which the council comes after them for the money. And yeah, I just think you've done a good thing. You could actually really go the extra mile by just kind of lifting that pressure off of people a little bit. But just a thought. You make a good point, Councillor Francis, and I think it's really helpful to have somebody in the room with some organisational history. If I were to make a guess, I guess from my perspective, maybe a guess I would make is it becomes difficult in terms of where do you draw the line, don't you? Do you draw the line at one year or two years or three years or four years? Because there's always a case, isn't there, for that. That would be my guess. And of course, if you backdate it, then it increases also that financial burden and that risk in terms of the additional pressure that we've been talking about. So there'd be the additional cost in terms of that demand that we know is coming in, and then you are, in a sense, backdating it. But I can certainly see from a constituent perspective how important that would be, how helpful that would be if we were able to do so. But I guess this is just my guess as a corporate director in terms of possibly maybe some of the things that may have been weighed up in relation to that. Okay, thank you very much. Thank you. Our next question will be asked. Jessica? Thank you, Chair. My question was actually answered by Margaret earlier. It was just about the comms and engagement. So thank you. Okay, thank you very much. Thank you. I can't take any more questions. Okay. Thank you all for your input today. The discussion around the revised charting policy are not just about budget. They are about people, and they can care their own. Free community care is essential for many, especially the elderly, those with disabilities, and people with long-term health issues. Access to care should be fair and not depend on someone's ability to pay. Equity must remain at the heart of any change we make. As we look at this revised policy, we must balance financial sustenance with our duty to protect the most vulnerable. We need a system that is both fair and accessible, ensuring that no one is left behind due to their financial situation. Thank you very much. Thank you very much for your time, and thank you very much for your coming. We can move to our next agenda. Thank you. Our last item is the winter funding update. This is important, particularly when it comes to supporting our vulnerable population. As colder temperature, I see a condition and increase. Health risks arise. Groups such as the elderly people with a disability or chronic health condition and low income, households face greater challenges. Effective winter funding ensures that our vulnerable residents receive access to essential services, including the heating support on health and social care. Can I welcome back to our cabinet member, Councillor Chaudhary. Can I also welcome Juliet Alunon, and Julie Dublin, Senior Manager. We can hand over to you. Your time will be 10 minutes. Thank you very much. Can you hear me? Thank you. Can I just introduce Chair Mary Jamal, Deputy Director of Aging Well and Unplanned Care. She's here joining us today. Thank you very much. I'm not going to take too long. There are quite a few slides here, so I'm going to try and go through them quite quickly. I may skip a few, but I'll share the slides if you haven't got them already anyway. Just to mention that on 16 September 2025, NHS England published their winter letter to ICB chairs and Chief Execs. There were three ambitions within that winter letter. One of them was to improve A&E performance with 78% of patients being admitted, transferred, or discharged within four hours. The second one was around improving category two ambulance response times. And the third one was to reduce 12-hour waits from time of arrival in ED. I'd just like to say that in terms of Tal Hamlett's position around A&E performance, we're currently achieving 72.34%, which is obviously just 6% below the standard. The standard is 78% by 31 March 2025, so we're hopeful that we'll get there as well. There are a number of areas that have been considered for winter, and one of them obviously is around vaccination and maximising our winter vaccination campaign, discharging into the community with local government colleagues and social care services, and also reviewing the ten high-impact interventions for urgent emergency care. We brought the impact interventions here the last time we spoke, but I'm just really cherry-picking some of the key ones from this list. I just want to make people aware that there is no additional winter funding that's been made available from NHS England this year. There's no indication that any is coming. We remain hopeful, but until such time, we just have to work with the allocations that we've received. So, just very quickly, in terms of the allocations that we do have, we have what's called physical capacity funding, of which 3 million has been made available for the hospital, particularly around general and acute beds. But for the hospital, it's split between the two sites, Royal London Hospital and Newham. We've had to, as part of the deficit that the ICS, and so that's the whole of North East London, so because of the deficit that the ICS is in, we've had to top slice our allocation by 10%. So the out-of-hospital fund is £723,000. But what I'm going to tell you later on is how we've disbursed that money across a number of schemes to support admission avoidance, discharge, and reducing length of stay. A key thing to note is that these schemes are still in draft. We have Tower Handlers Together Board and another meeting, the urgent care working group, where we're going to be bringing these schemes for sign-off. So it's a bit back to front at the moment, but that will be our governance to sign off those schemes. And also to note that because of the deficit, we had to go through what was called a triple lock process within the ICB, but that triple lock process has now been, we no longer have to go through that process, which is a positive step because that means we can effectively go ahead with the schemes once they've been approved through our local governance. So I'm going to skip through a couple of slides, which are obviously showing up on the wall. I just want to draw people's attention to the high-impact interventions. So there were four that we were responsible for last year, and that's all around improving some certain areas around same-day emergency care, frailty, intermediate care, and inpatient flow. We've had improvement in last year, but this year we are required across North East London and Tower Handlers obviously is part of that, to meet the minimum requirements for what's called a single point of access, particularly around winter. So effectively we're building our resilience over the winter period, and what's shown on the screens right now is really a roadmap as to how we're going to get there between now and March. But now what I'm going to take you through is the winter schemes, which is what you really want to hear about. There are a number of schemes that we've commissioned through our normal business, and so we've got Flu, we've got Community Pharmacy, Tal Hammers Connect, which we heard about here earlier, as well as social prescribing. These are the schemes that we don't have to find additional funding for because it's part of the normal business within the borough. We're looking at also optimizing flows through acute mental health and community trust, so we've got step-down provision that's been commissioned as well, and there are the normal businesses of position and response unit, rapid response, pharmacy, mental health, crisis response, and crisis cafe response lines as well. These are just a sample of the schemes that we already commissioned in the borough. The new schemes that we're looking to put in place include, I mentioned, the 11 general and acute beds in the Royal London Hospital. The schemes that we're talking about here are schemes that are funded through a range of pots of funding, but the key point about these schemes is that they're here to ensure that we reduce admissions into hospital and improve discharges out of hospitals, so really just improving hospital flow, because one of the key things that we do experience within the hospital is if we're unable to discharge patients, it puts increasing operational pressures on the hospital with the activity that comes through the front door. So I'm more than happy to walk you through each of the schemes that we've got. We've got about two pages of schemes if you would like to hear them, but I'll just give you a couple of them for example. So we're looking to commission additional step-down beds in the community, and additional resources certainly within social care. We're looking to increase the resources that we've actually got there. And within mental health, looking at increasing capacity for discharge to assess for mental health services. And just to say as well that within community health services, looking at schemes such as in-reach pharmacy, pharmacists working at the weekends, and also there's the virtual ward that already exists, but it's all part of ensuring that we can improve our discharge position. Those are just as an example of some of the schemes that we've commissioned with the funding that we've got available to us. And that funding includes what we call physical capacity funding. There's some BCF money in here as well, and there's also what we call adult social care discharge grant that makes up the bulk of the schemes that we've got here. Thank you for your presentation. Do you have any questions? Yes, starting from Amy. I've just got a really quick question, but just a little bit of a plea from me just before I do. And maybe I've just had a really long day, but I'm really struggling with this, because there's so many acronyms and there's so much in there that I don't know what on earth it's talking about. And I've been on this committee for two and a half years, so I used to be on this committee, but this one is a struggle. And I get that you're busy actually doing all this stuff, so I'm not expecting you to write and dumb things down for us, but I think just making sure it's accessible so that we can ask questions and we can prepare, that's really helpful. But my question, I've just spotted this, and I'm just thinking that it's really helpful One of the schemes is called High Intensity User Programme. I just wondered if you could explain to me what that is, because there is a scheme with a very similar name to this, which has caused an awful lot of problems and is unfortunately sneaking back into trust by stealth, another name, so I'd just be very interested to find out what this is and what it means. Okay, thank you for that. I'll take your point on board around the acronyms. I do try my best to make sure that it's really simplistic. No, it's not. Once you're in the zone, you're in the zone. So with respect to the High Intensity User Service, that's a service that's provided by East London Foundation Trust, predominantly the mental health team. It's been in place for, I think, about five years now. And it's a scheme around patients who attend repeatedly over the course of a month. These particular cohort of patients have got complex co-morbidities, which include mental health, social care needs, substance misuse, and this is a cohort that the service actually works with as part of a multi-medical system. It works with, as part of a multi-disciplinary team, to support them to adjust their behaviours and then bring them back to some sense of normality so that they can become active members of society. It's not... I'm not too sure which scheme you're referring to, but... That is the one, unfortunately. It's highly criticised because it involves the police quite heavily in mental health care, which is beyond inappropriate, but I don't think this is the forum to have. I think I'll probably send an email to the Trust about this one. Having said that, Councillor Lee, it'd be interesting to see the role of the police this time around, because we now know that there's a right person, right care. I can never remember which way round it is, which means that the police, in a sense, have kind of pulled back a bit in terms of some of those... But, yes, I take your point. Yes, OK. OK, then thank you very much. Before we can take the second question, if your colleague and you have any presentation or can you say something? You want to say anything, colleague? No? Are you sure? I think our next question will be asked Councillor Kovir Ahmad, please. Thank you, Julie, for your presentation. I'm quite disappointed by the table provided in this presentation, as there seems to include very little information on what those different works, Sims and Scream, actually delivered. In the future, could you document, write it to the committee, so that we have clear details about the support we are providing to the residents? No, no, no. Are you sure? Did you understand what he said? I did understand. I'm just waiting for the gentleman to turn off his mic so that I can speak. Thank you, Councillor, for your question. I just wondered if you can just clarify to me which table you're actually referring to. OK, then, that's fine. I'm more than happy. I'm more than happy to write it down for you and re-provide it to the committee. I'm probably asking for the more thorough detail. It was difficult to navigate through page 106, 105, those informations. I think what he's asking is, it's not much information, but it's a lot of condensed, so it's difficult for us to navigate through. Also, can I just mention that the document has been updated since it was sent out to you last week, so that's what the difference is. It has been changed from last week. So what I'll do is, by the end of this session, I'll make sure that it goes to Justina so that she can recirculate it. It's presented in a slightly different way, so it's easier to read, it's more accessible in the way that it's presented. Okay, do you want to say anything? Yeah, thank you. So I was just going to add to that to say, well, first of all, as Julie's already said, the version that's been on the screen is slightly different to the one you've got in your packs. But the point I was going to make is, this is a plan that's still in development. It's not finished yet. And as we finalise it, it will be a much stronger plan in terms of the link between NHS provision and social care and how those are working together over winter. So I think we can take on board your comments. And I would suggest that we circulate a final version rather than one that's still in development. And we can kind of take in your comments as we develop the final version. Okay, thank you very much. I think officer will be noted. Okay, next question will be asked. Councillor Mart. Yeah, thank you. Okay, thank you for this. In contrast, this is like a good amount of information for me because this is not an area that I know that much about or feel able to comment on very much. So what I would feedback is, it is more about experience and observation. So over the last four months, I've spent quite a bit of time in geriatric wards in a couple of hospitals, one of which was Wichita Cross which has a bad reputation was actually really good and it's worth putting that on record. But I wanted to just say that I think that this, I guess to kind of get to the principle about freeing up hospital beds to make sure that there's some excess capacity in the system so that the NHS doesn't go into crisis and start declaring all of the emergency situations that they have done in recent years. And I think it's really obvious to me having sat and listened, listened and talked to other families in similar situations that a really big part of it is about the fear of taking that step into nursing care, residential care, and the massive uphill battle that you have to go through with the NHS to get any kind of contribution towards those care costs, which might be entirely appropriate for you to be kind of suddenly having to pay £1,500, £2,000 a week for nursing care. But for a lot of people that's who, and often these come from kind of slips or falls and suddenly it's become a life-changing situation and they're having to deal with something that's really quite difficult to cope with in terms of like financially as well as physically and mentally. And yeah, it's just an observation that I think that much more needs to be done by the NHS itself to try to talk to families, to talk to the person in that situation, but families as well, about the options and about the support that's available, including independent advice that's kind of experienced advice around care costs. And I think that that would make a contribution towards easing some of this problem. It wouldn't solve it at all. The solution is more capacity, but yeah, maybe that will come soon. Thank you. Thank you very much. Do we have any more questions left? Councillor Abdelmanon? No. Jessica? Thank you, Chair. I just wanted to clarify on the... I don't know what page this is, but on the table with all the schemes on it, there are dates, so you've put some alive, and some October to March 25, and I wondered whether these are the dates of when they would take place, so the implementation, or is this limited by the funding? So are things funded for the five months, I guess? Thank you very much. So the dates on some of the schemes are ongoing, so they're live, so HIU, for instance, that's an ongoing scheme. The others that have a date of October to March, those schemes were just waiting to have the funding confirmed. But as I mentioned at the top of a bit of my presentation was that we're waiting for that funding to be confirmed, and we will confirm to the providers after our meeting on Thursday that they're able to move forward with those schemes. So some of the providers would have started those schemes at risk, effectively waiting for the funding to become available, but the dates are the dates that they're supposed to be starting. Is that okay? Thank you, Jessica. Councillor? Do you want to... Okay. I don't have a further question. I think it's really good that this is happening. I guess maybe one thing that might be useful is that we get some reflections from the team about how useful this has been, like once they've had a chance to breathe again in the spring or early summer, and what might be needed for the next year ahead. Thank you very much. Thank you. Winter planning is a vital responsibility for the Council, particularly in safeguarding vulnerable people a well-prepared approach, not only enhanced to the well-being of vulnerable people, but also strengthened the reliance of the entire community. Thank you very much for your time, and thank you very much for your coming. Thank you. Yes, Councillor Mark, go ahead. Thank you. I thought there were three really good presentations. This is an area of work that I think the Council, this Council does well, and yeah, I think we do... I don't want to kind of create work unnecessarily. I think people have got enough to be getting on with. I do think, though, as I've said in a previous meeting, one of the things that we have to do more is to scrutinise performance, and, you know, we've had a succession over the last few months of presentations around things, you know, generally which is talking about the upside, what's going well, highlighting the kind of things that rightly ought to be kind of promoted. But I do think that, you know, we might have to scratch a little bit beneath the surface, more on that. So I want to make a couple of suggestions, and it was mentioned about the linkage plus contract is up for recommissioning, and I think this committee should have a role in that process. I think, as the Chair, maybe it has a role in that process as well. But I think also, like, with this kind of external commission service, like, we need to understand some of the metrics ourselves as a committee. I understand that that's not necessarily appropriate to put into the public domain every single time, but I do think that should be shared, that some of that data should be shared. So Warwick talked about some of the KPIs, that there's a series of KPIs for that contract, and I wasn't sure, like, how the Connect one links to the linkage one. But that, so I would like to ask that we're given those and given some kind of historic performance data around that, so that, because I think you would want to feed in the committee's view about, you know, whether that's a really good contract, whether there's something that could be added to it, are they getting too much money, are they getting too little money, that sort of thing. I want to mention about us to push a bit harder on gateway housing as well. I think historically this has been a really good housing association. I don't see that level of performance at the moment on a general needs level, but I especially don't see it for tenants of sheltered accommodation. I've got two big blocks of sheltered in my ward, and tenants there are repeatedly complaining about the service that they're getting, but also they complain about the lack of communal activity. I think Gateway's done something about that in the last 12 months, but not enough, and I would like to know about the connection or what's being done to make sure that there's an opportunity for Linkage Plus Connect to go in and be speaking to residents directly. So that's on those two. Do you want me to say the home care one as well? So I think we should make a recommendation, or I think we should encourage further consideration of this point around the collection of historic debt in relation to home care charging. So I fully accept I'm the only member who's sitting around this table that was at the council at the time, and I was one of those that was obliged to support it at the time. I think it's been a really big problem for a number of residents, and I think that the approach that's taken to the collection of this historic debt is really... It needs to be thought out a little bit more. As I said to the lead member, I'm really encouraged by the approach that he's adopted so far, but I think just saying that we're going to collect this five and a half million and we're going to keep on squeezing people until they pay it, it doesn't really work for me when you're going to stop the charges. In particular, I still have constituents who were charged costs during COVID, during the pandemic, for services that they were not receiving at the time, including administration costs and things like that, and rightly, understandably for me, they're like, I'm not paying that. I didn't get anything. I'm not paying it. And so some of that will be mixed into that as well, but I'm interested if anyone else has got any thoughts about it. I don't think we can write a blank check, but I do think we can make it easier for people who are facing these costs. Thank you very much. Thank you, Mark. Our officer will be noted, and yes, Councillor Tabina Khan. Hi, I think with the winter planning, it would have been really good to see how many beds we have in total, that information, hospital beds, and how are they working in partnership with the hospitals and the local services, like a bit of communications, like in terms of what have they done, what's happening, so we can come back in three months' time and see that this is what they've done, that was good, positive, or we had issues with our performances, what indicate we didn't serve our elderly residents enough. So how do we know how many beds we have at the moment? Do we have enough beds for the elderly to support them through the winters if there is an emergency? So we don't know. We just, what are we assessing now? What's the benchmark now? Do we know, and how do we know how many people have been affected elderly and why they have been affected? What's the framework of winter planning? And I didn't also see, there's a lot of partnership data tables, but what are they trying to achieve with this partnership? What kind of communications have been happening? I would like to know that as well with winter planning, because it's the elderly who get affected the most, the pensioners and... The officer will be responsible. So what would be incredibly helpful to us as officers from you all as members of the committee is when you propose topics, if you could give us some sort of guidance, maybe with some questions in terms of areas you'd be particularly interested in, because these topics were set before I arrived, but when I arrived and we were preparing the documentation, these are such broad areas, it becomes quite difficult, because what we're doing as officers is we're almost trying to second guess what you would find helpful. So if you say winter planning, my goodness, we could spend a whole week talking about winter planning. So what would be really, really helpful is if we had a way in which you propose a topic, we get some insight into what would you find really helpful. So for instance, Councillor Francis, you say, it must really include some performance data, whether it's contractual information, or if it's winter planning, we want to get a sense of the beds and so forth. That would help us tremendously. So if we can come up with a way in which we could do that, I think it would really add value to this. Thank you. Thank you very much. Before we move to the close this meeting, I have some update to share under AOB. We have a scrutiny review on a maternity service in support for new mother. Our first session which looked at prenatal and during pregnancy will be taking place on 4th of December, 2024 in council chamber. Can I kindly request my committee colleague to be in attendance and support this support. This will be policy development work for this committee. And we have a second planning session will be 10th of February, 2025 on postnatal support. Our next normal subcommittee meeting, 3rd of February, 2024, so with no other business to discuss, I will call this meeting to close. Thank you very much. Thank you very much for your time and thank you very much for coming.